Automobile and Private Cars Essay

Advantages and disadvantages of television The advantages and disadvantages of television Nowadays many people all over the world spent most of their free time watching television; but since its appearance, television has brought to man many advantages as well as disadvantages. First, television plays an important role in our daily activities: it keeps us informed of all current affairs in the world. Events through television are more vivid than those through books and magazines. Second, television helps us enrich our spiritual lives. Our knowledge is broadened in many ways. Through language teaching programs, we can learn the language we like such as: English, French, German, Chinese, Japanese and so on. We can become skilful and clever at doing jobs, making cakes or arranging flowers through practical courses taught on television. Finally, television is a source of recreation. Humorous stories and funnyfilms bring us minutes of relaxation after a hard day’s work. For me, sitting comfortably in an arm-chair to watch an international football match on television is more interesting than having to queue for tickets at a crowded stadium. Apart from its advantages, however, television also brings lots of disadvantages to viewers too. First, television viewers gradually become passive in their action. Television may be a splendid media of communication, but it prevents us from communicating with each other or with the outer world. The world seen through television is only the restricted one: It separates us from the real world. Second, television, with its fascinating power, makes people of all ages sink into oblivion: whole generations are growing up addicted to the telly. Pupils and students are so absorbed in television that they neglect theirschool activities. Food is left uneaten, homework undone and lessons unprepared. Housewives are so keen on watching television that they neglect their duties toward their husbands and their children. Instead of watching television, we may use the time for a real family hour. Without the distraction of television, we may sit around together after dinner and actually talk to one another to know and like each other better. Finally, the evil influence of television on the young generation is inevitable; it encourages them to commit crimes. Spectacles of sadism and violence on television lead them to robbery, theft, rape and murder. In a nutshell, television is useful to us when we know how to use it: Be careful not to overindulge ourselves in it and use it in a discerning manner. Today there is some changes in the educational system. In your opinion, how should we change to raise the quality teaching? Education is to draw the best in children and to develop their faculties. Education is a complicated affair as it is supposed to equip children for life. Since life styles are always changing, the contents of education must also be changed accordingly. The school is supposed to provide necessary experiences to the child. When a child leaves the school, he may lead a useful life. But in the traditional school, the child was supposed to learn mainly the 3 R’s. So the chalk bard and the text books were the main stay of theteacher who was to shape the character of the child. Rote memory was insisted upon and examinations were based on this learning technique. There was not much of a difference from year to year on the way children were tested. The examinations conducted did not test all the faculties of the child. So, it was necessary for those who got through examinations to be trained afterwards. In short, children were very rarely taught to learn for themselves. This had continued for so long and the practice had to be abolished. Once this was realized, many new methods of teaching were tired and many new aids had been used for a better education of children. Today the school is a very complicated organization; the teacher is no longer the sole arbiter. The children, instead of being passive listeners, have been made active participants. They are handling, feeling, planning, creating and learning with newer tools and aids. The subjectivity has give place to healthy objectivity. In order to make education relevant and meaningful, children are exposed to almost life like situations. They must know how to live as good citizens and honest members of society. They must know how to live as good citizens and honest members of society. The way the school creates situations with these ends in views is important. On the intellectual side, the library and the laboratory must play a vital role. They complement and supplement more and more, and the use of library and the laboratory must be encouraged through proper assignments. The playing field, various camps, many organizations like the Junior Red Cross, etc. have to be fully utilized to shape the character of the child. Beside the text books, there are other aids for learning. They much be judiciously used. In fact, there are hundreds of ways in which the audio-visual aids can be used with advantage. Examinations must not be used to show weakness but must be a yardstick for proving the all-round education of the student. The questions must be objective and reliable. The examinations must be welcomed by the students. In order to satisfy the diverse population, there must be diversity in programs, approaches, resources and aims and room for experiment. Examinations should be a challenge for students. The world is shrinking and nobody can feel parochial. So education must equip students for world understanding and world citizenery. Science and technology must find their places in any scheme of education. Any system of education must help turn out a fully developed and all-rounded personality. The difficulties in learning English and how to overcome them. Beginners of foreign language always meet difficulties from the outset. For me, I had to overcome these problems when I started learning English. English pronunciation is my first obstacle. The pronunciation in English puzzles me a lot because the same letter has different sounds. For example the letter â€Å"a† in â€Å"bath† is not pronounced in the same way of that in â€Å"bathe†. The â€Å"ou† in â€Å"South† is also different from â€Å"ou† in â€Å"Southern†. Generally verbs and nouns are pronounced differently although they are written the same. Record is a good example to illustrate it. In order to solve this puzzling question I carefully study The A.P.A (The International Phonetic Alphabets) which helps me pronounce English words correctly. In order to have an accent just like the native speakers, I often listen to tapes and repeat after them, trying to imitate them. Moreover, myeveryday conversation with the foreigners I meet in the street will enable me to acquire a proper accent. Compared with French, English grammar is much easier. However, this does not mean that learners meet no difficulties in learning it. It took me a long time to learn how to master the tenses in English grammar, to endeavor to do as many grammar exercises as possible and read various grammar books. In writing English, English language has its own style. In order to drillwriting skills, I have tried to read famous novels of distinguished America and English writers. I enjoy the humorous style of writing in Mark Twain’s masterpieces, the elaborate and polished style of George Eliot and the sentimental and lyrical style of John Keats. After long and hard years of English study, how pleased I feel when I am able to read English and American authors without any obstacles and difficulties at all. Your favorite hobby Everybody has his or her own hobby. For me, my favorite hobby is reading books. My father was not only a writer but a researcher as well. He had a great collection of books on many fields: literature, science, art, fiction and non-fiction. After his death, I inherited the most valuable treasure which has been preserved carefully up to now. As I have a large collection of books of my own now, I usually spend hours reading and thinking about facts described in each kind of books. Sitting comfortably in an arm-chair in the library with a book open on my knee, I recall my father who was absorbed in his reading, perusing the poems of John Keats, William Words Worth, Chateaubriand and Lamartine. I still hear his sonorous voice reciting rhythmical lines of poems in Kim Van Kieu’s story while his face was radiant with ecstasy and raptures. Through books I see many countries rise and fall. Kings and Presidents pass before my eyes and I can follow the history of nations. Each book has a story to tell me of remote countries and strange people. I am greatly indebted to books indeed. For me a good book is not only a true companion but also a well-experienced teacher guiding me through my life. It has the miracle to relieve my suffering and my hardship and reveal to me strange and new horizons. Reading books broadens my mind and improves my knowledge. Instead of indulging myself in futile entertainments, I am often keen on reading books which are always a source of comfort and relief to me and I am determined to preserve my father’s valuable treasure for my posterity. In a few words, the reading of books contributes to the moral and intellectual formation of a man’s personality. A shopping day We live in the suburb of HCM city. Twice a week my mother and I usually take a bus to HCM city to do some shopping. Yesterday was my mother’s off-day. Early in the morning we took a bus to town. We were in town just after seven and we had the whole morning for shopping. First, we went to the ready-made clothes department. My mother bought two white shirts for my father, a pair of blue jeans for my brother. I chose a pink woolen sweater. I liked it very much because it perfectly suited my complexion. At this department prices were moderate and we did not need to bargain. Before leaving, my mother bought herself two pairs of gloves. Next, we went straight to the shoe department. The shop-assistant greeted us warmly. He showed us pairs of shoes of really good quality leather. Leather shoes and sandals of various sizes and colors were on sale. The store was crowded with customers. They were either looking at the shoes or buying them. We both chose fashionable pairs of shoes and left. It was nearly eleven o’clock. We called at a little cafà © by the street-side to have lunch. After lunch we went to the park nearby. We took a rest on the bench in the shade of tall trees, waiting for the shops to be open again in the afternoon. At 2:00 p.m. we returned to the shopping center. We went to the Chinaware department. My mother needed a dozen of dishes and bowls. Enameled chinaware of different beautiful patterns attracted housewives’ attention. Finally, before returning home, we went to the stationer’s. My mother bought lots of stationery: ink, pens, ball-point pens and writing pad. On the way to the bus station we called at the fast food department to get some ready-cooked food for the family when we got home. Returning home, I felt quite tired but how interesting a shopping day it was!e Life in the city, compared with life in the country In my opinion, urban life or rural life has its own advantages and disadvantages. First, living in the city we may enjoy those benefits. – Communication and transportation systems are better. There are so many means of communication and transport that we can choose the ones we like best. We can get in touch with a friend or talk to him by phone without having to go out of home. – Thanks to electricity network and running water, our material lives are more comfortable. Supermarkets, markets and shops are found everywhere and we can buy anything we need providing that we can afford it. – Urban life provides us with all sorts of entertainments: televisions, radios, movies, theatres, concerts and famous recreation centers. – Living in town we can improve our knowledge easily by attending any schools, universities or evening classes where experienced teachers and professors are ready to satisfy our thirst for knowledge. Besides its advantages, urban life also has its disadvantages: – Our health is in danger: pollution by factories and heavy traffic may cause serious diseases to all of us. – Evil influence upon the young generation by obscene video films is inevitable. – Violent deaths happen regularly in such a crowded city with all kinds of vehicles. On the contrary, rural life seems ideal to all of us, especially to the old. – We can enjoy fresh, cool air and behold beautiful landscapes in the country. – How safe and delighted we are when we can sleep a sound sleep at any time of the day without being disturbed by sirens of cars or by deafening noises from manufacturing factories. – Our social lives in the country are easier: we can eat the food and vegetables we grow, the chickens and goats we raise. The countrymen lead a very simple life and they are quick at mutual help in any case. Apart from these advantages, living in the country we may meet lots of difficulties too. – Communication and transportation are obstructed by lack of means of transport or by floods in the rainy season. – Our knowledge is limited by being short of mass media. – Our social and physical lives are not as comfortable as those in town because of lack of electricity and medical care. In a nutshell, our love for town life or country life depends on our outlook and age. As for me, I always prefer rural life to urban life. The Advantages and Disadvantages of Private Cars. Nowadays, as people’s life quality develops, more and more families can afford to buy private cars. On one hand, private cars can make the travel more convenient, A case in point, if you have a private car, you will not have to go to work in a crowded bus everyday and still worry about if you are going to be late. And when you want to travel in someplace, driving by yourself in your own car is the most convenient and comfortable way. While on the other hand, private cars can be very expensive and the price of petrol is getting higher and higher, taking a bus is a less expensive way when travelling. When a city has too many private cars, it becomes easy to cause traffic jam, especially when people go to work and go home after work. And you may need to wait for hours in your car.What’s more, more and more private cars also means more and more pollution to the environment. The gas that cars discharged is a serious pollution to the atmosphere. All in all, there are both advantages and diaadvantages of private cars. In my opnion, you can use your own car when it is necessary and if you are not in a hurry, you can take a bus instead.the birth of cars have made an enormous change to our life.in the past,we travel from one place to another only by foot,nowaday,cars can do it .its goes withour saying that the invention of cars bring great benefit to all of us. But as proverb goes:no garden without weeds.car is not exception. owing a car has a lot of advantages.for one thing,car provide us the most convient way of transportation.we can get around freely without spenting a lot of time.emotionally,i always found driving is so exciting.for another,its the comfortable to drive a car. In winter.drivers always can stay warm and dry even in rainy whether,in addition,drivers are usuall y safe in their cars when they are out at night. Cars bring the human merits,their side-effects graudually come to the surface.firstly,to run a car need a lot of oil,which is getting less and less.the increasing number of cars contribute the lacking of energy. Secondlly,as more and more cars are used,the traffic ecpecially in big cities is getting heaver and heavier,which lead to the serious social problem–traffic jam.in addition,the inceasing numbers of cars ,which excaust sent a huge quantities of carbon monoxide into atmosphere.it make the air of cities unbreathabe,it strip people contact with frensh air. therefore,the new energy should be explored to replace the oil so that our en vionmental pollution can be avioded .and the strick law should be issued to keep the numbers of cars under control.thus,our heavier traffic can be solluted! —- There are some advantages to owning a car in an urban area. First, sitting in your car is much more comfortable than having to wait a long time for the arrival of the bus or train. In bad weather the driver of the car is warm and comfortable and is always guaranteed a seat. Second, in urban areas it is much safer to be in your car, especially at night, than having to walk down a dark street to get to a bus stop or train station. On the other hand, there are some disadvantages to owning a car. First, a car is expensive. Gasoline is not cheap and car insurance rates in urban areas are very high. There are other expenses to be considered too, such as car maintenance and repairs as well as having to pay for parking. Second, owning a car causes a lot of worry and stress. If you leave your car in the street it might get stolen or its parts might get stolen. It is also very stressful to be driving on the freeway or in traffic jams and there is the constant fear and stress of being involved in an accident. Advantages & Disadvantages About Social Networking. 1. Purpose: To inform about social networking. 2. Main Idea: By the end of my speech the audience should get an idea about the advantages & disadvantages about our every day’s use of the social network. 3. Developed Main Ideas: There are 2 points I want you guys to be informed about. Social networking is a wonderful task we can do on the internet, although, there are advantages & disadvantages that comes with it. 4. Sub points: The advantages of social networking: – keep in touch with friends and family – be informed about around the world – get feedback about ideas or thoughts – ask questions, get fast answers – helps you learn more diversity and get exposure to multiple points of view.

Orion Systems Jaguar

What recommendations would you make to Rosas about organizing the Jaguar project, and why? Ans: Looking at the major assessment of problem of how ORION projects are manage, it will be plausible for Rosas to shift from the matrix structure and engage in a dedicated project teams structure. The reason been that is, dedicated project teams has a simple form of approach to a particular project where the functional organisation remain intact with the project team operating independently.It is also fast, meaning projects tend to get done more quickly rather than the matrix structure where you can be assigning multiple roles. It is very cohesive and this result in a high level of motivation which allows participants to share a common goal and take responsibility toward the project whiles the matrix structure there will be lack of strong project ownership.There is also cross-functional integration which allows specialists from different areas work closely together and, with proper guidance b ecome more committed to optimizing the project but not their respective areas of skill and this becomes the solution for the scope creep ORION has been encountering in terms of delays and design modifications that were inconsistent with customer requirements which was cause by the tendency for design engineers to get to absorb with the science of the project that they lost focus on practical considerations.ORION major problems of how project are manage; Higher than expected cost, Quality concerns, Problem with customer support, lack of strong project ownership and Scope creep 2) How would you change the organisational chart and master plan to reflect these changes? My chart ORION Organisational chart. Project manager Mechanics System engineer Electronics System engineer Deputy planning and control management Team Leader Team Leader Team Leader Team LeaderProject manager Team Leader Deputy planning and control management Electronics System engineer Mechanics System engineer Tradition al functional departments In organising projects as dedicated teams, the project manager becomes the team manager and work together with the rest of the team supported by the traditional functional department’s whiles in the matrix structure used by ORION each team have a different team leader. Master Plan Training Training programDocumentation and and test equipment SDR/PDR/CDR/TRR/PRR Build Production line Environment tests Laboratory tests and delivery Production Activities/time 6-12Months 1-6Months Design reviews Design and Development Production and Delivery ILS Lockheed martin justify that using a dedicated project teams structure facilitate a quick completion of a project.Now, if Lockheed martin uses 43days to complete an American fighter jet then I don’t see the reason why ORION will spend over 7years to make light-rail trains by using the matrix structure. Therefore, by using the dedicated project teams the process of tests, production and delivery can take le ss than the usual years ORION use to complete a particular project. So by using the dedicated project teams, I change the years on ORION master plan to months to reflect how fast it is to use the dedicated project teams rather than the matrix structure.

The Pricing of Health Costs and its Effect on the Poor in the United Dissertation - 1

The Pricing of Health Costs and its Effect on the Poor in the United States - Dissertation Example These families must forcibly cut down on their health care costs, which may ultimately lead to dangerous health consequences. In this context, the researcher will conduct a qualitative study (secondary research), that will explore the aspect of the monetary costs and quality of life,  as regards the present US health care system. Monetary costs and quality of life  in the context of US health care: in US, health care occupies an important position within the U.S. economy graph (Fig 1). Observations by various experts reveal that every year the health related expenditure keeps on growing, often moving ahead of the expenditure made on the other service sectors. This implies that each year the percentage of the health expenditure within the overall US economy pie keeps on growing. As the cost prices within the health care system increase, there is bound to be some sort of a repercussion within the average household, especially amongst the families that fall below the federal poverty line. ... Even for those people that have insurances, rising health care costs translate into getting less benefits each year, for the same amount of money. Fig 1: The US spends more healthcare than any country in the world. The figures as shown in the graph above represents health care expenditure for the year 2006, and during this year it was observed that an average US person spends more on health care than on food, oil, or even gasoline (Source: Mckinsey & company, 2008, 13). At an average estimate, America spends nearly $7,400 annually on health care per person, which comprises of about a 16% share within U.S. economy pie (fig 2). A look at the year 2007 will show us that US health care spending was then nearly $2.2 trillion, which when evenly spread over the entire population amounted to about $7421 per head expenditure (Figure 2). This $2.2 trillion represents 16.2 percent of the nation’s total economic activity, referred to as the gross domestic product or GDP. While the spendin g figures are by themselves impressive, however the chief area of concern is their rate of rapid growth over the last few years. Fig 2: National Health Expenditures per Capita and Their Share of Gross Domestic Product, 1960-2007 (Source: Health Care Costs- A Primer, 2009, 2). The graph (fig 2) shows the rising cost of health care per person in US. The growth in the last decade, starting from around 1990, and has been exponential. In 2009, the $7421 per head spending increased to more than $8000 per head, showing a jump of more than $500 per person, in just 2 years time (Centers for Medicare and Medicaid Services, 2010). Observations show that the rapidly increasing health care expenditure in US is becoming a

Project about drug LORATADINE OR LORATADIN Research Paper

Project about drug LORATADINE OR LORATADIN - Research Paper Example The assignment of patients to the different types of treatment was randomized and the randomization was also double-blinded, with neither the researchers nor the respondents knowing what treatment was assigned to them. At the start of each trial, the respondents assigned to each group were similar and baseline characteristics for each respondent were also similar. The baseline characteristic established for the patients included their age, gender, and ethnic origin (Ratner, et.al., 1998). Aside from the allocated treatment, the patients were all treated equally and no other additional procedures or treatments were included for any of the other treatment groups. There were 28 losses in respondents in the course of the study; this represented an acceptable number – less than 20% of the total number of respondents. The respondents were also analysed in the groups where they were randomised. They were analysed and compared to the other groups based on statistical variances and eva luations. This study is very much ideal because the clinicians and the researchers were blinded during the course of their research. Neither of them knew who was receiving what form of treatment. Previous knowledge and perceptions of the possible impact of treatments did not affect the results of the study and the outcome of the treatments (Ratner, et.al., 1998). The paper of Cauwenberge and Juniper (2000) sought to compare the efficacy, safety and impact of quality of life in seasonal allergic rhinitis patients after treatment with either fexofenadine and loratadine (with placebo) given once a day. The respondents were randomised through the application of appropriate computer techniques. Such randomisation was concealed from the respondents and researchers. The groups were similar at the start of the trial and the baseline characteristics of age, gender, and conditions including nasal congestion were all similar to each other (Cauwenberge &

The impacts of events Assignment Example | Topics and Well Written Essays - 2000 words

The impacts of events - Assignment Example Tourists’ focus then started to shift with the advancements in the event industry. As event planners came into the picture they realized that the tourism industry needed social events which lead to the event tourism industry (Lim & Lee, 2006). People usually travel to destinations for leisure and relaxation purposes but there are also people who travel to destinations for the purpose of business meetings, conferences, workshops and other similar social events. This movement of people has given rise to the event tourism industry (WTO, 1995). Events and tourism now go hand in hand, and so one without another seems incomplete. The perfect way to describe tourism would be to say that it takes a systematic planning process along with development and marketing of special events and festivals as tourist attractions (Kreag, 2001). These events are usually organized after looking at the behavior of tourists and the things which attract them towards a destination. Moreover, tourism mana gement aims at event tourism at complete utilization of the capabilities of events so as to attain overall tourism development. Event tourism also includes the research on people’s travelling motives which can be characterized as cultural, prestigious, physical, social and interpersonal motives and are pleased by diverse and unusual events. The Worlds Expo 2010, organized in Shanghai, China, was a similar event which was organized to seek attention of the world and to increase tourism prospects in China. It was a 184 days event which was eyed by the whole World. There are many credits given to the World Expo (2010) and so it was able to positively engage the world to China. China as a country has a history of hosting such events, but the Expo 2010 proved to be the best one indeed and was referred to as an event having its class apart. The standards set by the World Expo 2010 are very difficult to break by any other World Event such as this one. Socio - Cultural impact of the World Expo 2010 A country which has a good image in terms of social events just is more likely to make itself the spot for tourist attraction. The expected impacts of the Worlds Expo 2010 were positively seen on the host country, as through holding social events like these, a host country or the destination is able to make its own standing and create its brand image (Emma H. Wood, 2005). Also, since the country becomes famous for its culture and infrastructure, its resorts also become famous and many companies start holding their annual meetings and other conferences in that country, magnetizing more and more people towards it (Allen, 2009). Similarly, China had many benefits because of the World Expo, as the event was remarkably successful and attracted many countries towards it and the more a country is able to attract tourists, the more it is able to raise its finances through tourism (Solberg & Preuss, 2007). China has now become one of the best host countries, because of the im pression it created in front of the whole world, without the itinerary of such events, tourism is held incomplete (Henderson, 2006). Such events are not only created for revenue generation or for economic benefits but are also created to highlight the social culture of the country. These socio-cultural impacts go a long way to

Information Systems for Management- Research Conference Paper Essay

Information Systems for Management- Research Conference Paper - Essay Example Although there will be a good deal of positive emphasis on CRM's there will also include the other view point concerning the challenging areas that need improvements such as: project management, data conversion, customer relationships within the business, and the integrity of the CRM as a whole process. As stated previously, CRM's projectile aim is to consider the customer/business relationship first and foremost (ORC Macro, 2005). How a CRM goes about providing a company with a successful customer/business partnership is quite simple. It consists of a business process that uses correlating software along with traditional marketing methods such as: sales and other supportive measures to "retain and improve customer loyalty" (Penner & Ginsky, 2005). This type of strategy has proven very promising as a recent survey taken shows that 81% of some of the most reputable corporations have initiated CRM programming in the past three years and now have promising sketches to expand their basic CRM capabilities into 2004 through 2005 (Microsoft Business Solutions 2004, p.4). Factual evidence offers validity that CRM implementation is indeed on the rise and because of it almost 50% of firms utilizing CRM's services have had their revenue stack up very competitively against their competition over the past four years (Microsoft Business Solutions 2004, pp.1-4). Great prospects are available for CRM adaptation, which will soon be understood much more comprehensively through the research in this paper. CRM, in an integral whole part, forms the sound base structure for corporations to improve their already existing software systems. This creates a whole new highway of business which will be discussed later throughout this research project. Another area of focus this research will attempt to explore is the top three competitors which offer the services of CRM. These are: Oracle, Siebel and Sap, three of the most influential corporations offering some of the finest and top-notch software for all levels of companies. The main company focus will be Oracle due to the fact that it happens to be the most prestigious and quantifiable software corporation offering Integrated Customer Relationship Management solutions (Oracle, 2005). It happens to offer the most accurate, up-to-date key tools for customer success and the best thing is all entities within a company can draw on one main data source, if Oracle is the software of choice. Also, another reason the focus is so heavily on Oracle is due to the verifiable ability the software presents in assisting companies with their; "revenue, interaction costs, and customer relations" which stand unprecedented (Oracle, 2005). Study shows that this corporation leads Siebel and Sap, (han ds down), quite possibly due to the more user friendly interface of the system as well as the company's validated software track record also. The main purpose and aim of this research is to give validation and provide information into how CRM implementation aids in the long term success of a company. The fact that CRM does provide substantial assistance to companies in regards to building a more personal relationship with each customer, based on their own individual needs, and

Deaf History During Medieval Europe Essay Example | Topics and Well Written Essays - 1500 words

Deaf History During Medieval Europe - Essay Example There were only few deaf people of that period, they were famous, successfully, well educated for those times, some of them inherited titles of their ancestors despite their "disease", and some of them had strong positions in society, they took part in political life of their countries. It was only the one side of this problem. The following problem of medieval deaf people were in association of them with evil, witchcraft, and even the Devil. Children born with deafdisabilities were often perceived as the consequence of their mothers' support for satanic beliefs, illustrating both the ableist and patriarchal values of the era. However, it is also the case that under feudalism, deafdisabled people were generally able to make a contribution, in varying degrees, to a largely rural production process. If disabled people were hospitalized, it was in relatively small medieval hospitals where the focus was on palliative care rather than a cure. Such attitudes to deafdisabled people can be explained by the role... The church and feudal orders were meant to reflect heaven on earth - obedience to God via one's superiors: children obeyed their parents, their parents were their lord's vassals and had to obey him, the lord was the king's vassal, laymen obeyed the clergy, monks obeyed their abbot, clergy and laymen obeyed bishops who themselves were feudal lords, bishops and kings obeyed the Pope-at least in theory. Originality and creativity had to await a commission from the church or a lord, otherwise it was anathema. The church had created itself as a reborn "Imperium Romanum" with the Pope as its emperor and Latin as its language. And Church concidered that disabled people, and deaf ones too, were marked by Evil, by Demon. So, that was the thinking that people had: if you were different you were somehow marked. It is also important to say about the extention of the idea that Christ healed the disabled, so if you were disabled Christ did not favor you.The church alsoused this fear of disabilitie s as a threat to join the church or sickness and disabilities would affect you. Thus they hadtoconvince the people thatthose who were disabled or diseased must not be good Christians. The Church had such influence because medicine and science were in their infancy. Since the Church forbid dissection on humans, scienceandmedicine never really grew. People followed mostly a cause and effect approach. But to the end of Medieval period the attitudes to such people became to change, because among them there were very intelligent and talented people. What was the Hearing peoples view of Deaf during this period The industrial system of those times included weaving and artusaning. This required workers to complete tasks in accordance with

Competitive Strategies Essay Example | Topics and Well Written Essays - 500 words

Competitive Strategies - Essay Example †¢ To Achieve 95% customer satisfaction rating for Brand X. This goal can be accomplished by training employees on effective customer service, and improving the quality of the products or services using innovative technologies (Mahnken, 2012).†¢ To Achieve 95% customer satisfaction rating for Brand X. This goal can be accomplished by training employees on effective customer service, and improving the quality of the products or services using innovative technologies (Mahnken, 2012).†¢ Increase sales revenue by 10% within one year. This goal can be accomplished by using efficient inventory management methods and intensive promotional strategies.†¢ To improve the market share by 1%. This goal can be achieved by expanding to new geographical areas to get closer to customers, and using aggressive promotional strategies (Mahnken, 2012)†¢ Nokia – the company had been a leading mobile phone producer, but it has been overtaken by others including Samsung until it was acquired by Microsoft. In terms of strategy, the company lacked superior value proposition like iPhone’s prestigious value proposition by Apple and Android’s versatility value proposition by Samsung.†¢ Kodak – The Company maintained its film-based photography and failed to use the disruptive digital photography technology which disrupted its film-based model.†¢ Blockbuster – the company has failed to make use of disruptive technology and changing trends and internet security.  Companies with Differentiated products†¢ Apple – the company produces luxurious and prestigious products with high prices, including iPhones, iPads, and mac which target sophisticated consumers.†¢ Dropbox – offering freemium pricing strategy for storage services for businesses and individuals online.

Breast Cancer Essay Example | Topics and Well Written Essays - 2000 words

Breast Cancer - Essay Example Like all the cancerous growth, early stage breast cancer also does not produce any clinical manifestations to get it noticed early. Therefore, recommended check up guidelines should be followed regularly with alertness before major clinical manifestations are observed. Early stage diagnosis of breast cancer and its treatment, may actually cure the cancer. The different treatment alternatives for breast cancer include surgery, radiation therapy, hormonal therapy, and/or chemotherapy. Proactive preventive measures of cancer are related to reducing potential causes of breast cancer. Aromatase inhibitors are used to prevent recurrence in early-stage breast cancer and are under clinical trials as prevention measures in high-risk postmenopausal women. breast. In breast cancer, normal cells grow abnormally and give rise to transformed cells which eventually spreads in the body. These evade on healthy cells, tissues and organs by depriving them of essential nutrients and space. It is the second most leading cause of cancer mortality in US. National Cancer Institute has estimated that in the US, 0.5% women will develop breast cancer by the age of 50 and it may rise to10% by the age of 80 (Paddock). In 2007, it was estimated that 178,480 new females with invasive breast cancer will be diagnosed in addition to 62,030 cases of in situ breast cancer (Breast Cancer Facts & Figures 2007-2008, p.2). The breast cancer related deaths equal to 40,460 women was predicted in 2007. American Cancer Society has reported that breast cancer related deaths are declining due to increased awareness among the population. This decline could be directly attributed to more number of women undergoing screening test like mammography. This makes early diagnos is possible and early treatment leads to better clinical outcome in terms of improved survival rates. Still women between the ages of 45 and 55 are predisposed to breast cancer related

The Scream Essay Example | Topics and Well Written Essays - 1000 words

The Scream - Essay Example The essay "The Scream" tells the story about Baron Kingsley and the scream. Baron and his wife, Elsa, live near a wharf. They are married for five years now, since she got pregnant with their daughter, Eliza. When Baron sees Eliza, love swells inside him. But his wife is another thing. Sometimes, he loves Elsa, sometimes he doesn’t. Somehow, something changed since he came back from his Afghanistan post. He even thought that she would break her promise to marry him. Not that she promised. Of course, he proposed, and then she said yes. And that’s like a promise of some sort. The wharf knows everything. It witnessed his courtship and proposal. Nothing fancy with the proposal, but he did kneel. It felt wrong to not kneel when asking a lady to marry a knight. Also, Baron made sure that the day was blue and orange with sunset hues. Blue is calming and orange is a nice color too. It reminds him of fire, so hot it burns and it feels good burning. He likes playing with candles. He always tests how long his finger can take the flames. Going back to the proposal, Baron kneeled and asked his girlfriend to marry her. Elsa looked like someone expecting it for a long time. They have been together since high school. They broke up during college, and then found each other again, when Elsa worked at a military hospital. Baron’s having his regular check-ups there, and the rest, as they say, is history. The wharf creaked under Elsa’s jumps. â€Å"Yes! Yes! I will be Mrs. Kingsley!† In college, Elsa met her best friend, Duke

Internet Censorship Essay Example for Free

Internet Censorship Essay ThÐ µ capacity of thÐ µ information supÐ µrhighway has Ð µxplodÐ µd in thÐ µ rÐ µcÐ µnt yÐ µars. It Ð µncompassÐ µs thÐ µ Ð µast and thÐ µ wÐ µst, thÐ µ land and thÐ µ sÐ µa, and anything our human mind could drÐ µam of. This is a good thing, right? With thÐ µ knowlÐ µdgÐ µ of thÐ µ world just on onÐ µÃ¢â‚¬â„¢s fingÐ µrtips, it must bÐ µ good, right? SurÐ µ, if it is usÐ µd thÐ µ right way. A saying goÐ µs likÐ µ this, â€Å"Too much of a good thing is bad. † It is truÐ µ. ThÐ µ IntÐ µrnÐ µt doÐ µs accommodatÐ µ a lot of information. In a way, it has too much information. The Internet contains certain information that we DON’T want minors to have access of. Some of these unwanted information might be pornography, gambling, and some sensitive issues like homosexuality. So what do we do about the stuff that we don’t minors to see? Do we just make some law and erase it from our precious Internet? No. First of all, this would be impossible to do because there is just too much unwanted information. Second of all, this would defeat the purpose of the Internet. In the article â€Å"The Online Cooperative Publishing Act,† it called the Internet â€Å"the manifestation of humankind’s quest for limitless two-way interaction with thought† (â€Å"Cooperative† internet). Since there is a vague line of what is appropriate and what isn’t, why should there be a straight-cut line of what things should be banned on the Internet. There should be a loose regulation on the content of the Internet that would encourage more interaction with this wonderful tool. Instead of the government dictating what minors should see, parents and teachers should be the ones stepping up and TEACHING minors what’s right and what’s wrong. To maximize the productivity of the Internet, there must be a balance of restriction and freedom. When that balance is reached, the Internet will fully flourish. â€Å"Why should we protect the Internet? Why should we protect all those pornographic websites? † you might ask. The Internet is a wonderful thing. Even the heads of our nation, the President and Vice President, believe that the Internet is a â€Å"powerful educational tool for our children† (â€Å"Family† internet). It should not be viewed as an evil thing. Its unique ability to link the world’s knowledge together fulfills any researcher’s dream. There is no more need to visit dozens of libraries to find everything one needs. Everything is at one’s fingertips. Without a doubt, little kids wouldn’t need the Internet to do research; they don’t have any research paper due. One mustn’t forget the Internet is not just for research academically. It could be used to research recreationally. One can research on topic of his interest. A teen male can research about cars. A mom can research on recipes. And a little kid can research on his favorite Disney character. Because of the Internet, a kid can do a lot more things kids before didn’t have the privilege of. A kid can know anything and everything around the world, and even out of this world, without leaving the comfort of his home. Anything, anything at all. If the Internet is censored, a large amount of these wonderful knowledge will not be accessible anymore. Although censorship does not mean a complete ban, there is no measure at the present that can effectively restrict access and still not block out good website. According to a study done by Electronic Privacy Information Center, the filtering programs block 95-99 percent of the material available on the Internet that might be of interest to young people (â€Å"Faulty† internet). I am not defending the protection of pornographic websites. Neither am I advocating an easier access to pornography. I just want to point out the fact that websites dedicated to pornography is only a very small percentage of the Internet. If we use the inefficient censorship products out there, we will miss out a lot of the goods that the Internet has to offer. The Supreme Court believes the same. When the Supreme Court struck down the Communication Decency Act in 1996, it found that â€Å"the interest in encouraging freedom of expression in a democratic society outweighs any theoretical but unproven benefit of censorship† (â€Å"Faulty† internet). So, should we sacrifice all the goods that the Internet could offer for those measly pornography websites? The Supreme Court shared the same vision for an uncensored Internet when it struck down the Communications Decency Act, a federal law that outlawed â€Å"indecent† communications online. In the ruling, it declared the Internet a free speech zone.

Heart of darkness Essay Example for Free

Heart of darkness Essay It is a description of Marlows initial impressions and observations of the Outer Station, and all the slave labour going on. As he sees the land around him, he notices many mounds of turned up earth, and wastes of excavations, he speaks of the land as if it has been raped of all its resources, and left as a barren wasteland. His first impressions of the African slave workers seems racist, as he compares there black, naked bodies to ants, however, it is more likely that this is just a reference to the futility and uselessness of the work that is going on. His next observation is a boiler, and an undersized railway-truck. He describes them as dead like the carcass of some animal. There are several interpretations for this scene. One is that he has personified the machinery, giving them similar qualities to the slaves, describing the machinery as though it has been allowed to rest, and have its job taken over by slaves. Another interpretation is that the machinery is a symbol for the empire, as the machinery is slowly decaying and rusting, the empire is also declining. Another reference to the futility of this work appears a few lines down. The cliff was not in the way or anything; but this objectless blasting was all the work going on. It is as if the slaves have just been given something to do, to keep them from sitting around. As Marlow walks further on, he sees a guard carrying a gun, and wearing a jacket with one button of. This is a very deliberate observation, though the empire seems perfect from the outside, it has imperfections. On seeing Marlow, the guard raises his gun, and tries to see who Marlow is; Marlow is sarcastic at this point, joking about how white men all look the same at a distance, referring to how black people all look the same to him from a distance. As the guard recognises Marlow and smiles, there is more sarcasm from Marlow, describing the guards trust as being exalted, and describing himself as being a part of the great cause of these high and just proceedings. Marlow then descends down the hill, towards some trees. At this point, Marlow starts commenting some more on his pity for the slaves, and the pointlessness of the work going on. The first technique used to relay this to us is Conrads use of short sentences, like we are part of Marlows thought process. His first thoughts are about how futile and pointless all the work that is going on is. He describes one of the pits that has been dug, as just a hole. As he goes towards the trees for shade, he instantly regrets it, making a direct reference to Dantes Inferno. Dantes Inferno is one perception of what hell would be like. His vision of hell consists of seven rings, each ring containing people who have sinned a particular way, with the rings varying degrees of punishment. He looks around, noticing the slaves, objectifying them as black shapes. He makes an ironic comment, calling the slaves helpers and stating how they have withdrawn to die. He talks about how they have been abandoned in a very understating way. There is another reference to Dantes Inferno here, as he notices the black shadows of disease and starvation. Marlow then leaves the trees, but looks down to see a black slave, who has a white thread around his neck. He is startled at how strange and out of place it looks on the black skin. This is symbolic of the white men of the empire being out of place in Africa. To conclude, the Heart of Darkness within the play refers to the inner capability to commit evil acts in all men, and the evil of the empire underneath the front of spreading civilisation and the light of Christianity. The two sections of the novel which I have chosen to examine are full of symbolic imagery, referring to the title, and raising questions in the readers mind about the greatness of Britain.

Personality Disorder Carer and Family Support Impact

Personality Disorder Carer and Family Support Impact ARE PSYCHO-EDUCATIONAL AND SUPPORT PROGRAMMES FOR FAMILY AND CARERS EFFECTIVE IN REDUCING RELAPSES AND FACILITATING RECOVERY OF PEOPLE SUFFERING FROM PERSONALITY DISORDERS? ABSTRACT Background Carers and families of people suffering from personality disorder are in desperate need of support and services. Providing these services can reduce relapses and facilitate recovery in sufferers of personality disorder. The Research Question How can psycho-educational and support programmes for carers and families of those with personality disorder improve their recovery? Methodology The results of this study were obtained through a systematic literature review. Results Diagnosis and treatment of personality disorder are still complex and often confusing issues, even for professionals. Still, treatment can produce recovery and this recovery can be expedited if carers and families are provided with programmes to equip them to effectively face the challenges that personality disorder presents. Conclusions Providing psycho-educational and support programmes makes carers more effective and can help treat personality disorder. Social Workers can help to bridge a gap in the services that is adversely affecting the treatment outcomes of sufferers and hence placing greater strain on the Health System than is necessary. Contextualisation The carers and families of individuals suffering from personality disorders are an underserved population. Considerable strain is placed upon them and their loved ones and they are often at a loss as to how to effectively perform their duties and assist the recovery of those they care for. If more psycho-educational and support programmes for carers and families were provided, it is possible that treatment for personality disorder could be improved. Personality disorders can be defined as: â€Å". . . psychiatric conditions relating to functional impairment, or psychological distress resulting from inflexible and maladaptive personality traits.†1 Personality disorders are explained in the two most prominent classification schemes, the DSM-IV, where personality disorders can be found in Axis II, and the ICD-10. The definitions in these diagnostic classification systems are much the same. Defining ‘severe personality disorder has proved problematic for experts, who have yet to establish a generally accepted definition. The suggestion of the Royal College of Psychiatrists (1999) that severe personality disorder is marked by extreme societal disturbance and at least one extreme personality disorder has provided some guidance.2 Alternatively, having two severe disorders could mean that the sufferer has one disorder that expresses itself in more than one extreme way, or could simply indicate one deeply disturbing disorder. One study graded the severity of personality disorder on 163 subjects and found that the patients whose personality disorder was described as ‘complex demonstrated the greatest number of symptoms and recovered the least. Personality disorder carers are people who support a person who suffers from any form of personality disorder, whether they are relatives, friends or partners. Often, carers give sufferers emotional and financial support and may even act as informal social workers. Previous studies have shown that carers of people with personality disorder benefit from psycho-educational and support programmes. Psycho-educational programmes are educational programmes that contain an element of counselling or therapeutic activity for the family. The main aim of these programmes is to minimise the strain experienced by families and carers of people with mental illnesses, here personality disorder. Psycho-educational and counselling programmes exist ultimately to facilitate recovery and reduce relapses; indeed, the success of programmes is usually measured by examining relapse rates. Programmes attempt to provide adequate support, information, signposting to appropriate resources, advocacy and respite for carers. They also coach carers to increase their problem solving abilities, improve their communication and help them construct their own support networks. Support programmes for carers of people with a mental illness attempt to support the contribution that carers make to the lives of those they care for. They work toward advances in policy that will augment the services that satisfy carer requirements. Support programmes prompt dialogue between members of the government and carers, as well as encouraging carer involvement in the creation and delivery of carer and patient services. Further, support services connect carers with agencies to assist them in their role and facilitate modes of best practice in aiding carers. The Research Question This literature review examines a number of studies on personality disorder, its effect on carers and issues connected with diagnosis and treatment in an attempt to determine whether psycho-educational and support programmes for family and carers are effective in reducing relapses and facilitating recovery of people suffering from personality disorders. If social workers are to work effectively with this client base, they must put aside antiquated beliefs that personality disorder cases are hopeless and that those who suffer from personality disorder never get better. This study reveals that one of the greatest challenges to carers and families is obtaining the support they need and the services they are entitled to, and Social Workers can be instrumental in bridging gaps in the Mental Health system. Methodology This dissertation undertakes a systematic literature review of health care and psychological literature to address key issues in the support of carers of people suffering from personality disorders. Several different studies and a range of approaches were examined. Although the number and breadth of studies was a strength of the review, the variety of approaches made it challenging to compare the overall merits of one study against another. The literature was obtained through a variety of means. Google searches, journal articles, working group reports, service provider reports and academic papers were used. The research methods that appear in the utilised material included telephone interviews, questionnaires and surveys, face-to-face interviews and meta-analysis. Some were literature reviews themselves and some simply reported on the outcomes when a group of treated individuals was observed. Of the studies that involved observation of a group, very few included a control group in the study so methodological rigour was not as great as it could have been. Neither is it certain that studies where self-reporting was used are as empirically reliable as one would like, as sufferers of personality disorder tend to over- or under-report their symptoms . Some of the studies that were conducted recently showed positive outcomes, but the long-term follow-up for the same groups may make the figures less significant. Even where there has been longterm follow-up, some of those who took part in the initial study may not be included because of death, inability or unwillingness to participate, or inability to be located. The methodological rigour of the studies is further complicated by the fact that the process of diagnosis and treatment of personality disorder is fraught with complexities. The categories for personality disorder are somewhat defined by behaviours and are not theoretically based or grounded in common mechanisms of the disorder. The actions and symptoms of patients are so extremely varied that both diagnosis and treatment are difficult to present, much less to assess. Yet just because a comprehensive catalogue of truths about personality disorder cannot be presented does not mean that no reliable statements can be made. The evidence that is presented here is solid enough to make general assertions regarding the affects of carer support on patients based upon the evidence, and that is what it intends to do. Assessing the impact of support and education for carers upon the sufferers of personality disorder themselves proved more challenging than, for example, assessing the impact of treatment on sufferers, for which there is abundant literature. Still, the impact of psycho-educational and support programmes on consumers has been assessed and outcomes observed. Additionally, the evidence for the improvement of the lives of carers and the quality of care they give their charges is strong, and this fact bolsters the hypothesis that improved care for carers improves the mental health of those for whom they care. These conclusions are definitely linked, especially given the statistics that show that improvement for personality disorder takes place over a long period of time and is facilitated by positive interpersonal relationships with people who are equipped to deal with the symptoms that people with personality disorder exhibit. The presence of positive relationships with carers who are tr ained, educated and supported will assuredly improve the ‘treatment conditions for those with personality disorder. In narrowing the scope of the literature to be included in the study, several factors had to be noted. Some of the literature was so grounded in certain programmes for certain countries that many sections were not transferable to this review. For example, the results of the Network for Carers (2004) report were based upon specific programmes offered in Australia, so some information had to be excluded. However, this document was very helpful in establishing general facts about the needs of carers and the impact of programmes upon their ability to care for sufferers. It was also a thorough exposition of the opinions of carers,through which their voice was clearly heard. There were also other limitations regarding the particular demographic studied. The NHS National Programme on Forensic Mental Health Research and Development Expert Paper on Personality Disorders primarily assessed offenders with personality disorder and not merely members of the wider public suffering from the disorde r. Because of this, significant sections of the material had to be ignored. Still, this paper was useful in understanding the complexities of treatment and diagnosis of personality disorder, and provided definitions for contextualisation. In evaluating the quality of the data, the analytical tool Critical Appraisal Skills Programme (CASP) was used to assist in making sense of the evidence. This tool is advantageous to those who are strangers to qualitative research, assessing the merits of a source with regard to rigour, credibility and relevance.CASP initially asks two screening questions, the first addressing research aims and significance. The second screening question considers whether the research interprets subjective experiences of participants.Answering these two questions with a ‘yes then leads to eight more questions covering issues such as recruitment strategies, collection of data and ethical issues. In a literature review there are several ethical issues that must be considered, especially when dealing with a vulnerable population such as sufferers of mental illness. For each study used in the review it was necessary to consider whether ethical standards were maintained throughout the study, includi ng the manner in which consent was obtained and the way that confidentiality was upheld. Another ethical consideration is the handling of the outcomes of the study with the participants after the study.9 In the data observed here, it is not always explicit that consent was obtained but is often implied. Eliciting feedback from carers carries implied consent even if consent was not explicit, for obviously no individual would be forced to comment against his or her will. Confidentiality is maintained through omitting names and keeping the results impersonal. Yet the information given for studies is in its final and often abbreviated form, and the background work is not always documented comprehensively enough to ascertain whether all ethical considerations have been taken into account. One ethical consideration that is not always considered is the treatment of ethnic minorities in research projects, especially those for whom English is not their first language. The wording of questions and the criteria by which outcomes are judged is often tainted by cultural bias for those being assessed outside their native surroundings. It is practically impossible to remedy this, because part of the methodological rigour of the study depends upon all participants being treated and assessed in the same way. Differentiation on the basis of cultural differences would compromise the consistency of the study, but the impact of cultural factors is most certainly felt by those of foreign origin. Discussion of Findings Traits The traits exhibited by sufferers of personality disorder differ immensely because of the wide scope of the disorder. Examples of traits range from anxiety, narcissism and compulsivity to defiance, abnormal attachments and avoidance of social situations. Sufferers may demonstrate an arrogant interpersonal style, or may show extreme submissiveness. Personality disorders are linked with negative results in the wider population such as marital breakdown, criminal actions and professional difficulties.The anomalies of personality disorder are apparent in the thought patters, expressions and levels of self-control of sufferers. The patient will display abnormalities in the way that he or she interacts with others which will appear in a range of circumstances. There are various types of personality disorders, and each has its own banners of dysfunction. It has been recognised that the kinds of personality disorders covered in DSM and ICD are a small cluster when contrasted with the array o f personality impairments that can be identified in large configurations of people.11 Personality disorders can be divided into three clusters, A-C. In the first cluster disorders relating to paranoia and schizophrenia are found. Cluster B includes antisocial and narcissistic disorders, and Cluster C focuses on avoidant, dependent and obsessive-compulsive disorders. Prevalence It is estimated that between 6% and 15% of the population have one or more personality disorders of some kind—different studies produce different results.13 The goal of one study was to estimate the prevalence of personality disorders in a local sample and discern the most common demographic groups therein. The frequency of the DSM and ICD personality disorders and the interactions between disorder clusters and demographic qualities was assessed in a local sample of 742 participants between the ages of 34 and 94 over two years.14 The results showed that the overall prevalence of DSM-IV personality disorders was approximately 9%. Among the disorders, antisocial personality disorder was the most common and appeared in almost 5% of those assessed. Dependent personality disorder and narcissistic personality disorders were rare. The prevalence of many of the individual disorders was only 1% to 2%. For ICD-10 disorders, the overall presence in the surveyed group was 7%. Again, the prevalence for individual disorders was 1% to 2%. The most common disorder in for the ICD disorders was dissocial personality disorder at 3%. Dependent personality disorder was, again, very rare. Who is affected? Studies dedicated to uncovering the risk factors for personality disorder produced a variety of results. Prominent factors that may lead to a personality disorder include having a parent who is involved in or has been convicted of a crime, having a parent with deficient parenting abilities and being part of a large family. Factors such as low intelligence also feature in the list of risk factors. However, this study and studies that are similar raise certain issues about the nature of judging which factors should be included as risk factors for personality disorder. These sorts of factors could be criticised for having prejudicial antecedent assumptions regarding what it means to be a functioning human being. It is likely that people from lower socio-economic classes will have a tendency to fit these categories more than their middle- or upper class counterparts.Care should be taken in describing risk factors to ensure the language used is not biased by class. In the study mentioned above, several demographic characteristics were assessed with regard to prevalence of personality disorder. The outcomes demonstrated that Cluster A disorders were more common in males than in females. Cluster A disorders were also more prevalent in participants who were divorced or separated than those who were married or widowed. Subjects who had never been married were the most susceptible sub-group of all. In the Cluster B category, men were again more prone to having a personality disorder than women. Cluster B disorders were most common in the youngest age range surveyed and least common in the oldest range. Further, this cluster was most prevalent in participants who lacked a high school diploma and was least prevalent in participants who graduated from high school and continued their education afterwards. The odds of having one of these disorders decreased approximately 6% for each year an individual aged. One possible explanation for the increase of prevalence of disorder with age could be that people of more mature generations are less likely to have, know about or report symptoms of personality disorder. The prevalence of Cluster C disorders was most closely related to marital status, again showing that participants who had never been married were most likely to have one of these disorders. The likelihood of having a Cluster C disorder was almost 7 times greater in those never married when contrasted with those who were married or widowed. The results of this study broadly match a number of previous studies whose results showed the prevalence of personality disorders in the general population to be 9-13%. However, there were some differences between previous studies on prevalence and this study. The present study found a notably higher prevalence of antisocial personality disorder and a much lower prevalence of histrionic and dependent personality disorders than previous studies. These differences could have been caused by methodological variants and the diagnostic criteria used such as which version of the DSM was utilised. The differences could also be a result of participant source, form of assessment, assessors experience and data collection methods. Notable strengths of the study were that the participants were obtained through a community sample and personally interviewed by psychologists who have a significant amount of experience in cross-examination. The limitations included the fact that not all subjects coul d be interviewed and that the sample size was not really large enough to pick up on very rare disorders. The results of other studies have been less conclusive. An American study examined the theory that personality traits stop transforming by the time an individual reaches the age of 30. One of the major strengths of this study was the sample size of 132,515. The subjects, aged 21-60, participated in a web-based Big Five personality measurement. The results of this study showed that qualities such as being agreeable and conscientious increased during adulthood up through middle age. The quality of being neurotic diminished for women but remained static for men.20 Both men and women decreased in openness after the age of 30, and while men increased in extraversion from 31 to 60, the same quality diminished in women in the same age range.21 While the sample size of this study was certainly impressive, one concern was that conducting the study over the internet might bias it toward younger subjects. Another concern was the cohort effect, since people of earlier generations might not engag e with psychological instruments with the same ease as those who are younger. Overall, the multiplicity in paradigms of change did not affirm either that personality does not change after 30 or that it does. The study concludes that the traits examined are complex in nature and subject to an array of developmental influences. Historical View The onset of the de-institutionalisation of mental health establishments has produced a number of benefits. There is now less public stigma placed upon sufferers of mental illness and their traits and presence in wider society has come a long way toward normalisation. Suffers of mental illness have become less isolated and enjoy greater freedoms, including the freedom to choose from a selection of services. From a governmental point of view, deinstitutionalisation has saved them an enormous amount of money. However, the responsibility for managing and caring for mental illness sufferers has been transferred from the institution to the local community, and specifically to carers. Carers are involved in every possible aspect of the lives of their charges, even to the extent that their role could be characterised as an informal social worker. But the burden of the role combined with the lack of training, education and support often results in the damage of the psychological health of th e carer, as well as strict limitations on their life outside the caring role. The striking impact of caring on the lives of carers and other factors led to the undertaking of research on the involvement of families in managing and treating mental illness. From this came solid evidence of the benefits of such involvement, and the needs of carers began to be recognised. In recent years services have been put in place to assure that the needs of carers are met, and education for carers has been pinpointed as the most beneficial service for carers and consumers. Carers need to be educated in order to feel equipped to perform their tasks effectively. Specifically, carers named a need for â€Å"education about mental disorders† and information about treatment options† as their most salient needs. These statements are reinforced by studies from various countries where carers named the same things as most important for their success. Historically, studies examining the impact of educational programmes for carers have come from two different hypotheses. The first is that the chances of a consumer recovering from a mental illness are augmented if an educated and informed family surrounds him or her. Such a family will have deeper knowledge and sympathy for the condition of the sufferer and will be equipped to manage challenging behaviours. The second hypothesis is that because of the implications of their role, carers have an inherent right to access to adequate services. They have a right to services that will enhance their individual welfare and their effectiveness as carers. Assigning a course of treatment to personality disorder has always been an inexact science. Personality disorder is particularly complex to treat because the prime method of treatment is not always apparent after a diagnosis has been arrived at. The type of treatment which will prove most effective for the patient differs from individual to individual. Case conceptualisations can be helpful in assessing the individuals issues, identifying areas of risk and determining proper treatment goals.24 There is an abundance of research about treating personality disorder, but the studies cannot always be relied upon due to their lack of sound methodology. While some forms of treatment for personality disorder can reduce relapses and facilitate recovery, there is no simple panacea for this ailment. Cognitive treatments including cognitive-behavioural approaches have produced some pleasing results with personality disorder patients, as have psychodynamic treatments. Diagnosis Individuals who suffer from personality disorder encounter several issues with their diagnoses. They may be diagnosed through the means of an interview, a self assessment questionnaire or other means. Clinical psychiatrists often diagnose patients through interviewing them with regard to the DSM or ICD categories. This method is slightly better for detecting the existence or not of a personality disorder, but shows low accuracy for particular types of disorder. Self-report questionnaires like the Personality Diagnostic Questionnaire (PDQ-IV) and the Millon Clinical Multi-axial Inventory (MCMI) are also used to diagnose personality disorder. These questionnaires are considered imprecise because individuals tend to over-emphasise or under-emphasise the issues they are having. In addition to these methods of diagnosis, there are several semi-structured interview schedules to assist professionals. These schedules feature lists of questions that correlate to the DSM or ICD and the clinici an may then mark the patient and determine whether he or she has a disorder according to the criteria. Interview schedules have shown that they are slightly more reliable than other forms of diagnosis, but this success is only relative and the results are still much less valid than is needed. Really none of the diagnostic tools should be considered better than any of the others, for they are all faulty to the extent that they cannot be relied upon. There is a problematic absence of consensus regarding the reliability of diagnosing in general and the consistency of different diagnostic schemes. Part of the problem is that the explanations of personality disorders in the DSM and ICD feature a concoction of psychological traits and displayed behaviours, so that it becomes uncertain whether the diagnoses are attempting merely to pinpoint deviant actions or to identify traits whose presence is significant for determining personality disorder. The solidity of diagnoses for personality disorder is frequently questioned, and there are only a few disorders whose diagnoses are considered reliable. The diagnosis that can be made with the most certainty is antisocial personality disorder, because this problem can be identified by external actions that can be easily observed. Those who diagnose individuals with personality disorder are not always able to be precise in identifying which personality disorder they are dealing with, therefore m ultiple personality disorder diagnoses are common. Clinicians often find themselves confronting comorbidity, and prudent professionals test for the full scope of disorders. Comorbidity is quite common, with male legal psychopaths having an average of three disorders each. Women may have four.28 There is a great amount of interaction between the descriptors of the various types of personality disorder and so it is difficult to tell them apart. When dealing with multiple diagnoses, it is advisable to keep all disorders in mind when constructing a treatment regime, even if many of the features of the respective disorders overlap. The classification of disorders is also problematic, because the categories lack the quality of homogeneity present in reliable psychological categories of other types. Categories of psychological dysfunction work best when each class is different from others and common elements are contained within one class. This is not the case with personality disorders. For example, there are literally hundreds of ways to satisfy the criteria for borderline personality disorder, and so individuals with the same diagnosis may have utterly distinct behaviours, symptoms and needs. Axis I disorders feature frequently in those who suffer from personality disorder, particularly where there is substance abuse or depression. The classifications for personality disorder tend neither to be theoretically based, nor to stem from statistical research, which is presumably part of the reason that precise diagnoses are so elusive. The categories are so unreliable that abandoning the categories altogether and composing a new classification system is often proposed. While this may be the ideal way to correct the flaws, the time and effort already invested in the use of the present system is likely to ensure its continued existence. One approach to dealing with personality disorder is the trait approach. This approach states that a minimal amount of theories can illumine the majority of human behaviour. Observing the personality traits exhibited by an individual and placing them on a continuum from truly normal to extremely dysfunctional is more faithful to the structure of t he human psyche and tells clinicians more about the true nature of the dysfunction suffered by the patient. Currently, the most extensively developed trait theory relating to personality disorder is the theory of psychopathology. Treatment Cognitive-behavioural treatments (CBT) aimed at treating personality disorders have a tendency to take a broad approach. CBTs engage an array of behaviours, thoughts, preconceptions and internal emotional mechanisms. Many treatments are residential and are conducted with a group. They frequently include tenets of other methods such as psychodynamic therapy. Therefore it is an arduous task to pick out what, if any, elements are effective in a multi-dimensional approach so that they can be improved and repeated. Dialectical behaviour therapy (DBT) is a method of CBT focusing on female patients with borderline personality disorder. The goal of the therapy is to reduce or eliminate incidents of self-harm through group skills training. Group sessions address destructive thought patterns and social skills. Individual therapy can also be used. The outcomes for one study showed that women who were treated experienced reduced anger and self-destructive or suicidal thoughts. Their social skills improved and they required less psychiatric treatment. Arnold Lodge Regional Secure Unit has produced a treatment method aimed specifically at offenders with a personality disorder. The treatment programme centres on teaching patients socially acceptable mechanisms for problem solving. The patients work individually and with others and receive regular counselling. This regime is supplemented with services that are individually tailored to the needs of the individual, such as anger management sessions or substance abuse education. This form of treatment has been shown to reduce deficiencies in social functioning and self-control.32 While the initial studies are promising, long-term analysis will confirm or refute the true effectiveness of this type of treatment. Therapeutic communities, cognitive therapies and dynamic therapies may also be used to treat personality disorder. Therapeutic communities are tailored primarily for offenders and have produced promising results in terms of reduced recidivism and improved social integration. A study into the effectiveness of therapeutic community treatment of personality disorder explored whether this type of treatment improved the health of patients to the extent that the burden on Health Services eased. Several previous studies reported reductions in the use of psychiatric services after therapeutic community treatment. The previous studies were limited by the fact that they observed participants for one year only and lacked thorough follow-up. This study sought to fill the methodological gaps of the previous studies by tracking patients for years after treatment. They assessed the impact of treatment on Health Services by counting the number of admissions to hospital before and after treatment. Th e study found that therapeutic community treatment resulted in a statistically significant drop in in-patient admissions over the 3-year period. Those who were admitted to hospital tended to be the subjects who had the briefest experience of therapeutic community treatment. Another study involving therapeutic community treatment focused on individuals with severe personality disorder. The effect of p Personality Disorder Carer and Family Support Impact Personality Disorder Carer and Family Support Impact ARE PSYCHO-EDUCATIONAL AND SUPPORT PROGRAMMES FOR FAMILY AND CARERS EFFECTIVE IN REDUCING RELAPSES AND FACILITATING RECOVERY OF PEOPLE SUFFERING FROM PERSONALITY DISORDERS? ABSTRACT Background Carers and families of people suffering from personality disorder are in desperate need of support and services. Providing these services can reduce relapses and facilitate recovery in sufferers of personality disorder. The Research Question How can psycho-educational and support programmes for carers and families of those with personality disorder improve their recovery? Methodology The results of this study were obtained through a systematic literature review. Results Diagnosis and treatment of personality disorder are still complex and often confusing issues, even for professionals. Still, treatment can produce recovery and this recovery can be expedited if carers and families are provided with programmes to equip them to effectively face the challenges that personality disorder presents. Conclusions Providing psycho-educational and support programmes makes carers more effective and can help treat personality disorder. Social Workers can help to bridge a gap in the services that is adversely affecting the treatment outcomes of sufferers and hence placing greater strain on the Health System than is necessary. Contextualisation The carers and families of individuals suffering from personality disorders are an underserved population. Considerable strain is placed upon them and their loved ones and they are often at a loss as to how to effectively perform their duties and assist the recovery of those they care for. If more psycho-educational and support programmes for carers and families were provided, it is possible that treatment for personality disorder could be improved. Personality disorders can be defined as: â€Å". . . psychiatric conditions relating to functional impairment, or psychological distress resulting from inflexible and maladaptive personality traits.†1 Personality disorders are explained in the two most prominent classification schemes, the DSM-IV, where personality disorders can be found in Axis II, and the ICD-10. The definitions in these diagnostic classification systems are much the same. Defining ‘severe personality disorder has proved problematic for experts, who have yet to establish a generally accepted definition. The suggestion of the Royal College of Psychiatrists (1999) that severe personality disorder is marked by extreme societal disturbance and at least one extreme personality disorder has provided some guidance.2 Alternatively, having two severe disorders could mean that the sufferer has one disorder that expresses itself in more than one extreme way, or could simply indicate one deeply disturbing disorder. One study graded the severity of personality disorder on 163 subjects and found that the patients whose personality disorder was described as ‘complex demonstrated the greatest number of symptoms and recovered the least. Personality disorder carers are people who support a person who suffers from any form of personality disorder, whether they are relatives, friends or partners. Often, carers give sufferers emotional and financial support and may even act as informal social workers. Previous studies have shown that carers of people with personality disorder benefit from psycho-educational and support programmes. Psycho-educational programmes are educational programmes that contain an element of counselling or therapeutic activity for the family. The main aim of these programmes is to minimise the strain experienced by families and carers of people with mental illnesses, here personality disorder. Psycho-educational and counselling programmes exist ultimately to facilitate recovery and reduce relapses; indeed, the success of programmes is usually measured by examining relapse rates. Programmes attempt to provide adequate support, information, signposting to appropriate resources, advocacy and respite for carers. They also coach carers to increase their problem solving abilities, improve their communication and help them construct their own support networks. Support programmes for carers of people with a mental illness attempt to support the contribution that carers make to the lives of those they care for. They work toward advances in policy that will augment the services that satisfy carer requirements. Support programmes prompt dialogue between members of the government and carers, as well as encouraging carer involvement in the creation and delivery of carer and patient services. Further, support services connect carers with agencies to assist them in their role and facilitate modes of best practice in aiding carers. The Research Question This literature review examines a number of studies on personality disorder, its effect on carers and issues connected with diagnosis and treatment in an attempt to determine whether psycho-educational and support programmes for family and carers are effective in reducing relapses and facilitating recovery of people suffering from personality disorders. If social workers are to work effectively with this client base, they must put aside antiquated beliefs that personality disorder cases are hopeless and that those who suffer from personality disorder never get better. This study reveals that one of the greatest challenges to carers and families is obtaining the support they need and the services they are entitled to, and Social Workers can be instrumental in bridging gaps in the Mental Health system. Methodology This dissertation undertakes a systematic literature review of health care and psychological literature to address key issues in the support of carers of people suffering from personality disorders. Several different studies and a range of approaches were examined. Although the number and breadth of studies was a strength of the review, the variety of approaches made it challenging to compare the overall merits of one study against another. The literature was obtained through a variety of means. Google searches, journal articles, working group reports, service provider reports and academic papers were used. The research methods that appear in the utilised material included telephone interviews, questionnaires and surveys, face-to-face interviews and meta-analysis. Some were literature reviews themselves and some simply reported on the outcomes when a group of treated individuals was observed. Of the studies that involved observation of a group, very few included a control group in the study so methodological rigour was not as great as it could have been. Neither is it certain that studies where self-reporting was used are as empirically reliable as one would like, as sufferers of personality disorder tend to over- or under-report their symptoms . Some of the studies that were conducted recently showed positive outcomes, but the long-term follow-up for the same groups may make the figures less significant. Even where there has been longterm follow-up, some of those who took part in the initial study may not be included because of death, inability or unwillingness to participate, or inability to be located. The methodological rigour of the studies is further complicated by the fact that the process of diagnosis and treatment of personality disorder is fraught with complexities. The categories for personality disorder are somewhat defined by behaviours and are not theoretically based or grounded in common mechanisms of the disorder. The actions and symptoms of patients are so extremely varied that both diagnosis and treatment are difficult to present, much less to assess. Yet just because a comprehensive catalogue of truths about personality disorder cannot be presented does not mean that no reliable statements can be made. The evidence that is presented here is solid enough to make general assertions regarding the affects of carer support on patients based upon the evidence, and that is what it intends to do. Assessing the impact of support and education for carers upon the sufferers of personality disorder themselves proved more challenging than, for example, assessing the impact of treatment on sufferers, for which there is abundant literature. Still, the impact of psycho-educational and support programmes on consumers has been assessed and outcomes observed. Additionally, the evidence for the improvement of the lives of carers and the quality of care they give their charges is strong, and this fact bolsters the hypothesis that improved care for carers improves the mental health of those for whom they care. These conclusions are definitely linked, especially given the statistics that show that improvement for personality disorder takes place over a long period of time and is facilitated by positive interpersonal relationships with people who are equipped to deal with the symptoms that people with personality disorder exhibit. The presence of positive relationships with carers who are tr ained, educated and supported will assuredly improve the ‘treatment conditions for those with personality disorder. In narrowing the scope of the literature to be included in the study, several factors had to be noted. Some of the literature was so grounded in certain programmes for certain countries that many sections were not transferable to this review. For example, the results of the Network for Carers (2004) report were based upon specific programmes offered in Australia, so some information had to be excluded. However, this document was very helpful in establishing general facts about the needs of carers and the impact of programmes upon their ability to care for sufferers. It was also a thorough exposition of the opinions of carers,through which their voice was clearly heard. There were also other limitations regarding the particular demographic studied. The NHS National Programme on Forensic Mental Health Research and Development Expert Paper on Personality Disorders primarily assessed offenders with personality disorder and not merely members of the wider public suffering from the disorde r. Because of this, significant sections of the material had to be ignored. Still, this paper was useful in understanding the complexities of treatment and diagnosis of personality disorder, and provided definitions for contextualisation. In evaluating the quality of the data, the analytical tool Critical Appraisal Skills Programme (CASP) was used to assist in making sense of the evidence. This tool is advantageous to those who are strangers to qualitative research, assessing the merits of a source with regard to rigour, credibility and relevance.CASP initially asks two screening questions, the first addressing research aims and significance. The second screening question considers whether the research interprets subjective experiences of participants.Answering these two questions with a ‘yes then leads to eight more questions covering issues such as recruitment strategies, collection of data and ethical issues. In a literature review there are several ethical issues that must be considered, especially when dealing with a vulnerable population such as sufferers of mental illness. For each study used in the review it was necessary to consider whether ethical standards were maintained throughout the study, includi ng the manner in which consent was obtained and the way that confidentiality was upheld. Another ethical consideration is the handling of the outcomes of the study with the participants after the study.9 In the data observed here, it is not always explicit that consent was obtained but is often implied. Eliciting feedback from carers carries implied consent even if consent was not explicit, for obviously no individual would be forced to comment against his or her will. Confidentiality is maintained through omitting names and keeping the results impersonal. Yet the information given for studies is in its final and often abbreviated form, and the background work is not always documented comprehensively enough to ascertain whether all ethical considerations have been taken into account. One ethical consideration that is not always considered is the treatment of ethnic minorities in research projects, especially those for whom English is not their first language. The wording of questions and the criteria by which outcomes are judged is often tainted by cultural bias for those being assessed outside their native surroundings. It is practically impossible to remedy this, because part of the methodological rigour of the study depends upon all participants being treated and assessed in the same way. Differentiation on the basis of cultural differences would compromise the consistency of the study, but the impact of cultural factors is most certainly felt by those of foreign origin. Discussion of Findings Traits The traits exhibited by sufferers of personality disorder differ immensely because of the wide scope of the disorder. Examples of traits range from anxiety, narcissism and compulsivity to defiance, abnormal attachments and avoidance of social situations. Sufferers may demonstrate an arrogant interpersonal style, or may show extreme submissiveness. Personality disorders are linked with negative results in the wider population such as marital breakdown, criminal actions and professional difficulties.The anomalies of personality disorder are apparent in the thought patters, expressions and levels of self-control of sufferers. The patient will display abnormalities in the way that he or she interacts with others which will appear in a range of circumstances. There are various types of personality disorders, and each has its own banners of dysfunction. It has been recognised that the kinds of personality disorders covered in DSM and ICD are a small cluster when contrasted with the array o f personality impairments that can be identified in large configurations of people.11 Personality disorders can be divided into three clusters, A-C. In the first cluster disorders relating to paranoia and schizophrenia are found. Cluster B includes antisocial and narcissistic disorders, and Cluster C focuses on avoidant, dependent and obsessive-compulsive disorders. Prevalence It is estimated that between 6% and 15% of the population have one or more personality disorders of some kind—different studies produce different results.13 The goal of one study was to estimate the prevalence of personality disorders in a local sample and discern the most common demographic groups therein. The frequency of the DSM and ICD personality disorders and the interactions between disorder clusters and demographic qualities was assessed in a local sample of 742 participants between the ages of 34 and 94 over two years.14 The results showed that the overall prevalence of DSM-IV personality disorders was approximately 9%. Among the disorders, antisocial personality disorder was the most common and appeared in almost 5% of those assessed. Dependent personality disorder and narcissistic personality disorders were rare. The prevalence of many of the individual disorders was only 1% to 2%. For ICD-10 disorders, the overall presence in the surveyed group was 7%. Again, the prevalence for individual disorders was 1% to 2%. The most common disorder in for the ICD disorders was dissocial personality disorder at 3%. Dependent personality disorder was, again, very rare. Who is affected? Studies dedicated to uncovering the risk factors for personality disorder produced a variety of results. Prominent factors that may lead to a personality disorder include having a parent who is involved in or has been convicted of a crime, having a parent with deficient parenting abilities and being part of a large family. Factors such as low intelligence also feature in the list of risk factors. However, this study and studies that are similar raise certain issues about the nature of judging which factors should be included as risk factors for personality disorder. These sorts of factors could be criticised for having prejudicial antecedent assumptions regarding what it means to be a functioning human being. It is likely that people from lower socio-economic classes will have a tendency to fit these categories more than their middle- or upper class counterparts.Care should be taken in describing risk factors to ensure the language used is not biased by class. In the study mentioned above, several demographic characteristics were assessed with regard to prevalence of personality disorder. The outcomes demonstrated that Cluster A disorders were more common in males than in females. Cluster A disorders were also more prevalent in participants who were divorced or separated than those who were married or widowed. Subjects who had never been married were the most susceptible sub-group of all. In the Cluster B category, men were again more prone to having a personality disorder than women. Cluster B disorders were most common in the youngest age range surveyed and least common in the oldest range. Further, this cluster was most prevalent in participants who lacked a high school diploma and was least prevalent in participants who graduated from high school and continued their education afterwards. The odds of having one of these disorders decreased approximately 6% for each year an individual aged. One possible explanation for the increase of prevalence of disorder with age could be that people of more mature generations are less likely to have, know about or report symptoms of personality disorder. The prevalence of Cluster C disorders was most closely related to marital status, again showing that participants who had never been married were most likely to have one of these disorders. The likelihood of having a Cluster C disorder was almost 7 times greater in those never married when contrasted with those who were married or widowed. The results of this study broadly match a number of previous studies whose results showed the prevalence of personality disorders in the general population to be 9-13%. However, there were some differences between previous studies on prevalence and this study. The present study found a notably higher prevalence of antisocial personality disorder and a much lower prevalence of histrionic and dependent personality disorders than previous studies. These differences could have been caused by methodological variants and the diagnostic criteria used such as which version of the DSM was utilised. The differences could also be a result of participant source, form of assessment, assessors experience and data collection methods. Notable strengths of the study were that the participants were obtained through a community sample and personally interviewed by psychologists who have a significant amount of experience in cross-examination. The limitations included the fact that not all subjects coul d be interviewed and that the sample size was not really large enough to pick up on very rare disorders. The results of other studies have been less conclusive. An American study examined the theory that personality traits stop transforming by the time an individual reaches the age of 30. One of the major strengths of this study was the sample size of 132,515. The subjects, aged 21-60, participated in a web-based Big Five personality measurement. The results of this study showed that qualities such as being agreeable and conscientious increased during adulthood up through middle age. The quality of being neurotic diminished for women but remained static for men.20 Both men and women decreased in openness after the age of 30, and while men increased in extraversion from 31 to 60, the same quality diminished in women in the same age range.21 While the sample size of this study was certainly impressive, one concern was that conducting the study over the internet might bias it toward younger subjects. Another concern was the cohort effect, since people of earlier generations might not engag e with psychological instruments with the same ease as those who are younger. Overall, the multiplicity in paradigms of change did not affirm either that personality does not change after 30 or that it does. The study concludes that the traits examined are complex in nature and subject to an array of developmental influences. Historical View The onset of the de-institutionalisation of mental health establishments has produced a number of benefits. There is now less public stigma placed upon sufferers of mental illness and their traits and presence in wider society has come a long way toward normalisation. Suffers of mental illness have become less isolated and enjoy greater freedoms, including the freedom to choose from a selection of services. From a governmental point of view, deinstitutionalisation has saved them an enormous amount of money. However, the responsibility for managing and caring for mental illness sufferers has been transferred from the institution to the local community, and specifically to carers. Carers are involved in every possible aspect of the lives of their charges, even to the extent that their role could be characterised as an informal social worker. But the burden of the role combined with the lack of training, education and support often results in the damage of the psychological health of th e carer, as well as strict limitations on their life outside the caring role. The striking impact of caring on the lives of carers and other factors led to the undertaking of research on the involvement of families in managing and treating mental illness. From this came solid evidence of the benefits of such involvement, and the needs of carers began to be recognised. In recent years services have been put in place to assure that the needs of carers are met, and education for carers has been pinpointed as the most beneficial service for carers and consumers. Carers need to be educated in order to feel equipped to perform their tasks effectively. Specifically, carers named a need for â€Å"education about mental disorders† and information about treatment options† as their most salient needs. These statements are reinforced by studies from various countries where carers named the same things as most important for their success. Historically, studies examining the impact of educational programmes for carers have come from two different hypotheses. The first is that the chances of a consumer recovering from a mental illness are augmented if an educated and informed family surrounds him or her. Such a family will have deeper knowledge and sympathy for the condition of the sufferer and will be equipped to manage challenging behaviours. The second hypothesis is that because of the implications of their role, carers have an inherent right to access to adequate services. They have a right to services that will enhance their individual welfare and their effectiveness as carers. Assigning a course of treatment to personality disorder has always been an inexact science. Personality disorder is particularly complex to treat because the prime method of treatment is not always apparent after a diagnosis has been arrived at. The type of treatment which will prove most effective for the patient differs from individual to individual. Case conceptualisations can be helpful in assessing the individuals issues, identifying areas of risk and determining proper treatment goals.24 There is an abundance of research about treating personality disorder, but the studies cannot always be relied upon due to their lack of sound methodology. While some forms of treatment for personality disorder can reduce relapses and facilitate recovery, there is no simple panacea for this ailment. Cognitive treatments including cognitive-behavioural approaches have produced some pleasing results with personality disorder patients, as have psychodynamic treatments. Diagnosis Individuals who suffer from personality disorder encounter several issues with their diagnoses. They may be diagnosed through the means of an interview, a self assessment questionnaire or other means. Clinical psychiatrists often diagnose patients through interviewing them with regard to the DSM or ICD categories. This method is slightly better for detecting the existence or not of a personality disorder, but shows low accuracy for particular types of disorder. Self-report questionnaires like the Personality Diagnostic Questionnaire (PDQ-IV) and the Millon Clinical Multi-axial Inventory (MCMI) are also used to diagnose personality disorder. These questionnaires are considered imprecise because individuals tend to over-emphasise or under-emphasise the issues they are having. In addition to these methods of diagnosis, there are several semi-structured interview schedules to assist professionals. These schedules feature lists of questions that correlate to the DSM or ICD and the clinici an may then mark the patient and determine whether he or she has a disorder according to the criteria. Interview schedules have shown that they are slightly more reliable than other forms of diagnosis, but this success is only relative and the results are still much less valid than is needed. Really none of the diagnostic tools should be considered better than any of the others, for they are all faulty to the extent that they cannot be relied upon. There is a problematic absence of consensus regarding the reliability of diagnosing in general and the consistency of different diagnostic schemes. Part of the problem is that the explanations of personality disorders in the DSM and ICD feature a concoction of psychological traits and displayed behaviours, so that it becomes uncertain whether the diagnoses are attempting merely to pinpoint deviant actions or to identify traits whose presence is significant for determining personality disorder. The solidity of diagnoses for personality disorder is frequently questioned, and there are only a few disorders whose diagnoses are considered reliable. The diagnosis that can be made with the most certainty is antisocial personality disorder, because this problem can be identified by external actions that can be easily observed. Those who diagnose individuals with personality disorder are not always able to be precise in identifying which personality disorder they are dealing with, therefore m ultiple personality disorder diagnoses are common. Clinicians often find themselves confronting comorbidity, and prudent professionals test for the full scope of disorders. Comorbidity is quite common, with male legal psychopaths having an average of three disorders each. Women may have four.28 There is a great amount of interaction between the descriptors of the various types of personality disorder and so it is difficult to tell them apart. When dealing with multiple diagnoses, it is advisable to keep all disorders in mind when constructing a treatment regime, even if many of the features of the respective disorders overlap. The classification of disorders is also problematic, because the categories lack the quality of homogeneity present in reliable psychological categories of other types. Categories of psychological dysfunction work best when each class is different from others and common elements are contained within one class. This is not the case with personality disorders. For example, there are literally hundreds of ways to satisfy the criteria for borderline personality disorder, and so individuals with the same diagnosis may have utterly distinct behaviours, symptoms and needs. Axis I disorders feature frequently in those who suffer from personality disorder, particularly where there is substance abuse or depression. The classifications for personality disorder tend neither to be theoretically based, nor to stem from statistical research, which is presumably part of the reason that precise diagnoses are so elusive. The categories are so unreliable that abandoning the categories altogether and composing a new classification system is often proposed. While this may be the ideal way to correct the flaws, the time and effort already invested in the use of the present system is likely to ensure its continued existence. One approach to dealing with personality disorder is the trait approach. This approach states that a minimal amount of theories can illumine the majority of human behaviour. Observing the personality traits exhibited by an individual and placing them on a continuum from truly normal to extremely dysfunctional is more faithful to the structure of t he human psyche and tells clinicians more about the true nature of the dysfunction suffered by the patient. Currently, the most extensively developed trait theory relating to personality disorder is the theory of psychopathology. Treatment Cognitive-behavioural treatments (CBT) aimed at treating personality disorders have a tendency to take a broad approach. CBTs engage an array of behaviours, thoughts, preconceptions and internal emotional mechanisms. Many treatments are residential and are conducted with a group. They frequently include tenets of other methods such as psychodynamic therapy. Therefore it is an arduous task to pick out what, if any, elements are effective in a multi-dimensional approach so that they can be improved and repeated. Dialectical behaviour therapy (DBT) is a method of CBT focusing on female patients with borderline personality disorder. The goal of the therapy is to reduce or eliminate incidents of self-harm through group skills training. Group sessions address destructive thought patterns and social skills. Individual therapy can also be used. The outcomes for one study showed that women who were treated experienced reduced anger and self-destructive or suicidal thoughts. Their social skills improved and they required less psychiatric treatment. Arnold Lodge Regional Secure Unit has produced a treatment method aimed specifically at offenders with a personality disorder. The treatment programme centres on teaching patients socially acceptable mechanisms for problem solving. The patients work individually and with others and receive regular counselling. This regime is supplemented with services that are individually tailored to the needs of the individual, such as anger management sessions or substance abuse education. This form of treatment has been shown to reduce deficiencies in social functioning and self-control.32 While the initial studies are promising, long-term analysis will confirm or refute the true effectiveness of this type of treatment. Therapeutic communities, cognitive therapies and dynamic therapies may also be used to treat personality disorder. Therapeutic communities are tailored primarily for offenders and have produced promising results in terms of reduced recidivism and improved social integration. A study into the effectiveness of therapeutic community treatment of personality disorder explored whether this type of treatment improved the health of patients to the extent that the burden on Health Services eased. Several previous studies reported reductions in the use of psychiatric services after therapeutic community treatment. The previous studies were limited by the fact that they observed participants for one year only and lacked thorough follow-up. This study sought to fill the methodological gaps of the previous studies by tracking patients for years after treatment. They assessed the impact of treatment on Health Services by counting the number of admissions to hospital before and after treatment. Th e study found that therapeutic community treatment resulted in a statistically significant drop in in-patient admissions over the 3-year period. Those who were admitted to hospital tended to be the subjects who had the briefest experience of therapeutic community treatment. Another study involving therapeutic community treatment focused on individuals with severe personality disorder. The effect of p